Impact of Age on Use of Neoadjuvant Chemoimmunotherapy and Outcomes for Patients with Triple-Negative Breast Cancer

Following KEYNOTE-522, there is limited population-level data regarding the use and outcomes of neoadjuvant chemoimmunotherapy (NACI) for triple-negative breast cancer (TNBC) management across patient ages. We examined trends in the use of NACI and neoadjuvant chemotherapy (NAC) without immunotherapy in TNBC patients stratified by age groups and impact on pathological complete response (pCR) and overall survival (OS).

Adult women with nonmetastatic TNBC who underwent NAC/NACI between 2012 and 2022 were selected from the National Cancer Database. These patients were compared overall and stratified by age group (< 50 years, 50-70 years, and >70 years) based on receipt of NACI or NAC.

A total of 56,606 patients were included. Use of NACI significantly increased from 2012 to 2022 with a concomitant decrease in NAC (p < 0.0001), although women >70 years received significantly less NACI in 2022 than other age groups (p < 0.0001). Women had greater pCR rates in the breast and axillary lymph nodes with NACI compared with NAC overall (relative risk 1.405, p < 0.0001), with women >70 years receiving the greatest benefit (relative risk 1.56, p < 0.0001). All women had greater OS with NACI over NAC (hazard ratio 0.704, p < 0.0001), especially women 50-70 years.

Use of NACI for TNBC patients has increased over the past decade. NACI was associated with higher pCR rates and greater OS over NAC in all women, especially > 70 years. These data suggest that older TNBC patients may achieve significant clinical benefit from this regimen.